Which of the following is the first to improve after surgery for GH producing adenoma?

Trans-sphenoidal surgery is the preferred primary treatment for management of micro and macro-adenomas leading to acromegaly. The first symptom to improve is Soft tissue Swelling. Soft tissue swelling manifests as increased Heel pad thickness, increased shoe and glove size, ring tightening, coarse facies and large fleshy nose. GH hormones levels normalise in First hour and IGF levels normalise in 3-4 days. Also note that in case of prolactin producing macro-adenoma first line treatment is medical treatment. In case of resistance surgery is done.